How To Use CPT Code 27226

CPT 27226 describes the open treatment of a posterior or anterior acetabular wall fracture with internal fixation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27226?

CPT 27226 can be used to describe the open treatment of a posterior or anterior acetabular wall fracture with internal fixation. This code is used when a provider performs a surgical procedure to fix the fracture using implants such as plates, pins, or screws.

2. Official Description

The official description of CPT code 27226 is: ‘Open treatment of posterior or anterior acetabular wall fracture, with internal fixation.’

3. Procedure

1. The provider makes an incision over the hip joint and dissects through the subcutaneous tissue to expose the acetabulum.
2. They inspect the acetabulum and remove any fracture fragments.
3. The provider then reduces or realigns the fractured bones in the front or rear joints that form the acetabulum.
4. For a posterior joint fixation, they use implants such as plates and screws, nails, or wires to support the fractured bones.
5. For an anterior break, they may use a two-screw method to secure the fractured bone, directing the screws away from the joint on an angle from behind the acetabular surface.
6. The wound is closed by suturing the skin layers together, and a closed suction drain may be placed.
7. The patient’s leg is placed in a brace for four to six weeks to limit stress on the fractured bones.
8. An X-ray examination may be performed to confirm the reduction of the fracture.

4. Qualifying circumstances

Patients eligible for CPT 27226 are those with a posterior or anterior acetabular wall fracture that requires open treatment with internal fixation. The procedure is performed by a provider who is qualified to perform this type of surgery.

5. When to use CPT code 27226

CPT code 27226 should be used when a provider performs an open treatment of a posterior or anterior acetabular wall fracture with internal fixation. This code should not be used for other types of fractures or procedures.

6. Documentation requirements

To support a claim for CPT 27226, the provider must document the following information:

• Patient’s diagnosis of a posterior or anterior acetabular wall fracture
• Description of the procedure performed, including the use of internal fixation implants
• Date of the procedure
• Details of the reduction or realignment of the fractured bones
• Any additional procedures performed, such as the placement of a closed suction drain
• Post-operative instructions and follow-up plans
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 27226, ensure that the procedure meets the criteria for this code. It is important to use the appropriate diagnosis code to support medical necessity. Follow the specific guidelines provided by the payer for accurate and timely reimbursement.

8. Historical information

CPT 27226 was added to the Current Procedural Terminology system on January 1, 1993. It was initially removed from the Inpatient Only (IPO) list in 2017 but was later added back in 2022.

9. Examples

1. A provider performs an open treatment of a posterior acetabular wall fracture with internal fixation using plates and screws.
2. A patient undergoes open treatment of an anterior acetabular wall fracture with internal fixation, securing the fractured bone with a two-screw method.
3. A provider performs an open treatment of a posterior acetabular wall fracture with internal fixation and iliac crest bone graft.
4. An individual undergoes open treatment of an anterior acetabular wall fracture with internal fixation and acetabular rim fracture fixation.
5. A provider performs open treatment of an acetabular fracture, including internal fixation, using plates and screws.
6. A patient undergoes open treatment of a posterior acetabular wall fracture with internal fixation and femoral head bone graft.
7. A provider performs open treatment of an anterior acetabular wall fracture with internal fixation and acetabular rim fracture fixation.
8. An individual undergoes open treatment of a posterior wall acetabular fracture with or without internal fixation.
9. A provider performs open treatment of an anterior wall acetabular fracture with or without internal fixation.
10. An individual undergoes open treatment of an acetabular fracture, including internal fixation, when performed.